Healthcare Provider Details

I. General information

NPI: 1447026877
Provider Name (Legal Business Name): ANAHI DOMINICCI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 EUBANK BLVD NE STE 6
ALBUQUERQUE NM
87112-5300
US

IV. Provider business mailing address

1201 EUBANK BLVD NE STE 6
ALBUQUERQUE NM
87112-5300
US

V. Phone/Fax

Practice location:
  • Phone: 505-620-1199
  • Fax:
Mailing address:
  • Phone: 505-620-1199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number76624
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number76624
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: